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The influence of scar on the spatio-temporal relationship between electrical and mechanical activation in heart failure patients


Maffessanti, Francesco; Jadczyk, Tomasz; Kurzelowski, Radosław; Regoli, François; Caputo, Maria Luce; Conte, Giulio; Gołba, Krzysztof S; Biernat, Jolanta; Wilczek, Jacek; Dąbrowska, Magdalena; Pezzuto, Simone; Moccetti, Tiziano; Krause, Rolf; Wojakowski, Wojciech; Prinzen, Frits W; Auricchio, Angelo (2020). The influence of scar on the spatio-temporal relationship between electrical and mechanical activation in heart failure patients. Europace, 22(5):777-786.

Abstract

AIMS
The aim of this study was to determine the relationship between electrical and mechanical activation in heart failure (HF) patients and whether electromechanical coupling is affected by scar.
METHODS AND RESULTS
Seventy HF patients referred for cardiac resynchronization therapy or biological therapy underwent endocardial anatomo-electromechanical mapping (AEMM) and delayed-enhancement magnetic resonance (CMR) scans. Area strain and activation times were derived from AEMM data, allowing to correlate mechanical and electrical activation in time and space with unprecedented accuracy. Special attention was paid to the effect of presence of CMR-evidenced scar. Patients were divided into a scar (n = 43) and a non-scar group (n-27). Correlation between time of electrical and mechanical activation was stronger in the non-scar compared to the scar group [R = 0.84 (0.72-0.89) vs. 0.74 (0.52-0.88), respectively; P = 0.01]. The overlap between latest electrical and mechanical activation areas was larger in the absence than in presence of scar [72% (54-81) vs. 56% (36-73), respectively; P = 0.02], with smaller distance between the centroids of the two regions [10.7 (4.9-17.4) vs. 20.3 (6.9-29.4) % of left ventricular radius, P = 0.02].
CONCLUSION
Scar decreases the association between electrical and mechanical activation, even when scar is remote from late activated regions.

Abstract

AIMS
The aim of this study was to determine the relationship between electrical and mechanical activation in heart failure (HF) patients and whether electromechanical coupling is affected by scar.
METHODS AND RESULTS
Seventy HF patients referred for cardiac resynchronization therapy or biological therapy underwent endocardial anatomo-electromechanical mapping (AEMM) and delayed-enhancement magnetic resonance (CMR) scans. Area strain and activation times were derived from AEMM data, allowing to correlate mechanical and electrical activation in time and space with unprecedented accuracy. Special attention was paid to the effect of presence of CMR-evidenced scar. Patients were divided into a scar (n = 43) and a non-scar group (n-27). Correlation between time of electrical and mechanical activation was stronger in the non-scar compared to the scar group [R = 0.84 (0.72-0.89) vs. 0.74 (0.52-0.88), respectively; P = 0.01]. The overlap between latest electrical and mechanical activation areas was larger in the absence than in presence of scar [72% (54-81) vs. 56% (36-73), respectively; P = 0.02], with smaller distance between the centroids of the two regions [10.7 (4.9-17.4) vs. 20.3 (6.9-29.4) % of left ventricular radius, P = 0.02].
CONCLUSION
Scar decreases the association between electrical and mechanical activation, even when scar is remote from late activated regions.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Cardiocentro Ticino
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Cardiology and Cardiovascular Medicine
Health Sciences > Physiology (medical)
Language:English
Date:1 May 2020
Deposited On:22 Oct 2020 09:13
Last Modified:23 Oct 2020 20:00
Publisher:Oxford University Press
ISSN:1099-5129
OA Status:Closed
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1093/europace/euz346
PubMed ID:31942982

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